Endoscopic fastener remover

ABSTRACT

A surgical apparatus for removing fasteners from the body includes an endoscopic portion for insertion through an endoscopic tube and a fastener removing assembly positioned at the distal end of the endoscopic portion. By engaging a fastener with the fastener removing assembly, a surgeon can actuate the assembly and cause the fastener to distort to a configuration suitable for removal from the body.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to surgical fastener removers, and moreparticularly relates to surgical fastener removers for use in endoscopicand laparoscopic procedures.

2. Discussion of the Prior Art

Laparoscopic and endoscopic surgical procedures are minimally invasiveprocedures in which operations are carried out within the body by meansof elongated instruments inserted through small entrance openings in thebody. The initial opening in the body tissue to allow passage of theendoscopic or laparoscopic instruments to the interior of the body maybe a natural passageway of the body, or it can be created by a tissuepiercing instrument such as a trocar. With the aid of a cannula assemblyinserted into the opening, laparoscopic or endoscopic instrumentationmay then be used to perform desired surgical procedures.

Laparoscopic and endoscopic surgical procedures generally require thatany instrumentation inserted in the body be sealed, i.e. provisions mustbe made to ensure that gases do not enter or exit the body through theinstrument or the entrance incision so that the surgical region of thebody, e.g. the peritoneum, may be insufflated. Mechanical actuation ofsuch instruments is for the most part constrained to the movement of thevarious components along a longitudinal axis with means provided toconvert longitudinal movement to lateral movement where necessary.Because the endoscopic or laparoscopic tubes, instrumentation, and anyrequired punctures or incisions are relatively narrow, endoscopic orlaparoscopic surgery is less invasive and causes much less trauma to thepatient as compared to procedures in which the surgeon is required tocut open large areas of body tissue.

Surgical fasteners or staples are often used to join body tissue duringlaparoscopic and endoscopic procedures. Such fasteners typically have apair of legs joined by a backspan and are set into the body by means ofan elongated instrument which crimps the fastener legs to secure thefastener and tissue. Once a fastener is crimped into place, it may benecessary to remove the fastener. This need can arise when a fastener ismisplaced or otherwise determined to be in an undesirable location.However, it is extremely difficult to remove the fastener withoutcausing damage to the surrounding tissue, especially due to the natureof minimally invasive surgery wherein the fastener must be manipulatedfrom a position outside the body.

Various types of surgical fastener or staple removers are known but arenot suited for endoscopic procedures. For example, U.S. Pat. No.4,589,631 discloses a surgical staple remover comprising two pivotallyconnected arms, each of which is made up of a proximal handle and adistal nose piece. The apparatus operates in a manner similar to a pairof pliers- the surgeon grasps a staple backspan with the nose piece ofthe remover and then squeezes the handles to bend the staple's backspanto cause the staple legs to pull out of the body. In operation, however,such surgical fastener removers are not suited for endoscopic orlaparoscopic surgery because they cannot be inserted into a cannulaassembly.

Therefore, the novel surgical apparatus pursuant to the presentinvention advantageously provides an endoscopic surgical fastenerremover configured and dimensioned to be fully operational within afinite space, such as in an abdominal cavity and a cannula assembly, toremover fasteners which have been applied endoscopically.

SUMMARY OF THE INVENTION

The present invention provides a novel endoscopic or laparoscopicsurgical apparatus which is a lightweight, easy to use and may beoperated with one hand. The apparatus comprises an endoscopic portionhaving fastener removing means positioned at the distal end and fastenerremoving actuating means positioned remote from the fastener removingmeans.

The endoscopic portion may further comprise an outer tube, configuredand dimensioned to be inserted through a cannula, and an inner rodslidably disposed therein. The fastener removing means comprises astationary member and a movable member disposed within a distal nosepiece. The inner rod is connected at a distal end to the movable memberof the fastener removing means and at its proximal end to the fastenerremoving actuating means. The actuating means comprises a handleassembly wherein there is at least one stationary handle and at leastone pivotable handle. With the inner rod connected to a pivotablehandle, manipulation of the pivotable handle causes the inner rod toslide axially within the outer tube. This provides means for controlledmovement of the movable member of the fastener removing means andenables the surgeon to remove fasteners from the body. The outer tubeand inner rod of the endoscopic portion can be rotatably connected tothe handle assembly, advantageously allowing the surgeon to rotate thefastener removing means to a desired orientation without rotating theentire handle assembly. The present invention may also include a lockingmechanism disposed within the handle assembly in order to secure theinner rod, and therefore the movable member of the fastener removingmeans, in a fixed position relative to the outer tube.

In operation, a surgeon can rotate the endoscopic portion and fastenerremoving means to align the removing means with the backspan of afastener. Once aligned, the apparatus can be maneuvered to cause thebackspan to become located between the movable and stationary members ofthe fastener removing means. By pivoting the pivotable handle, thesurgeon can then cause the inner rod and, therefore, the movable memberof the fastener removing means, to slide axially. Axial movement of themovable member towards the stationary member of the fastener removingmeans will cause the fastener to become pressed therebetween. Furthermovement of the pivotable handle, inner rod, and movable member of thefastener removing means causes the fastener to distort to aconfiguration suitable for removal. An optional locking mechanismdisposed within the handle assembly can provide means to ensure that themovable and stationary members of the fastener removing means do notmove relative to each other while the uncrimped fastener is beingremoved, thus preventing an undesired release of the fastener into thebody cavity.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing objects and other features of the invention will becomemore readily apparent and may be understood by referring to thefollowing detailed description of illustrative embodiments of theendoscopic or laparoscopic surgical apparatus for removing fasteners,taken in conjunction with the accompanying drawings, in which:

FIG. 1 illustrates a perspective view of a first embodiment of anendoscopic or laparoscopic surgical apparatus of the present invention;

FIG. 2 illustrates a side plan cut-away view of the fastener removingportion of the apparatus;

FIG. 2A is cross sectional view taken along lines 2A--2A of FIG. 2;

FIG. 3 illustrates an exploded perspective view of the endoscopic andfastener remaining portions of the apparatus of FIG. 1;

FIGS. 3A and 3B illustrate alternate embodiments of the forked portionsof the fastener removing means;

FIG. 4 illustrates a side plan cut-away view of the handle assemblydepicting the movement of the pivotable handle from the open to theclosed position;

FIG. 4A illustrates a front view of the latching mechanism of FIG. 4;

FIG. 4B is a cross sectional view taken along lines 4B--4B of FIG. 4A;

FIG. 5 illustrates a side plan cut-away view of the handle assembly,depicting the movement of the pivotable handle from a closed position toan open position;

FIG. 6 illustrates the apparatus approaching a fastener to be removedfrom the body;

FIG. 6A illustrates the apparatus engaging a fastener prior todistortion of the fastener.

FIG. 6B illustrates a fastener after being deformed by the apparatus.

FIG. 7 illustrates a perspective view of a second embodiment of anendoscopic or laparoscopic surgical apparatus of the present invention;

FIG. 8 illustrates a side plan of the apparatus of FIG. 7 showing aportion of the handle assembly cut away and depicting the movement ofthe pivotable handle from the open to the closed position;

FIG. 9 illustrates the apparatus of FIG. 8, depicting the movement ofthe pivotable handle from the closed to the open position;

FIG. 10 illustrates a cross sectional view taken along lines 10--10 ofFIG. 7.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now in specific detail to the drawings, in which likereference numerals identify similar or identical elements, FIG. 1illustrates a first embodiment of the endoscopic or laparoscopicsurgical apparatus 10 for removing surgical fasteners. Apparatus 10comprises endoscopic portion 14, which is configured and dimensioned tobe inserted into a cannula, handle assembly 12 and fastener removingassembly 20. Handle assembly 12 is positioned at the proximal end ofendoscopic portion 14 and functions to actuate the fastener removingassembly 20, which is positioned at the distal end of endoscopic portion14. The fastener removing assembly 20 of this embodiment has astationary member, which functions to press against and deform thebackspan of a fastener, and a movable member having parallel spacedapart forks, which functions to engage the backspan of a fastener andforce the backspan against the stationary member.

FIGS. 2 and 3 illustrate fastener removing assembly 20 and itsrelationship with endoscopic portion 14. Endoscopic portion 14 includesouter tube 16 and inner rod 18 slidably disposed therein. Inner rod 18includes distal notch 104, central axial groove 106, and proximal axialgroove 108. Nose piece 15 is positioned at a distal end of outer tube16, with extension 100 sitting within distal opening 17 of outer tube16.

With reference to FIGS. 2, 2A and 3, fastener removing assembly 20includes slidable channel 22 and stationary member 28 positionedtherein, both of which are attached to nose piece 15 via pin 25. Pin 25extends through openings 19 and 19' in the distal end of nose piece 15,through opening 110 in stationary member 28, and through elongated slot23 in slidable channel 22. Elongated slot 23 allows for sliding movementof channel 22, which will be described below. Notch 104 of inner rod 18engages the proximal end of channel 22 at aperture 102 such that the twopieces are in axial sliding relationship (e.g., along a longitudinalaxis) within nose piece 15. Channel 22 has parallel spaced apart forks24 and 24' positioned at its distal end and at an angle to thelongitudinal axis of channel 22 for purposes of engaging and grasping afastener to be removed (see also FIGS. 6 and 6A).

FIGS. 3A and 3B illustrate alternative embodiments of forks for engagingthe fasteners. Forks 26 and 26' in FIG. 3A are rectangular in shape andhave an increased surface area. Forks 27 and 27' in FIG. 3B areessentially trapezoidal. Fork transverse bar 112 is disposed between theparallel forked pairs and has barbs 29 and 29' disposed thereon. Theconfigurations of the forks may be modified to control the manner inwhich the fastener distorts during removal or to meet specific fastenerrequirements.

Handle assembly 12 (FIGS. 4 and 5) includes distal stationary handle 30,proximal pivotable handle 32 and latching mechanism 54. Stationaryhandle 30 and pivotable handle 32 are connected by pivot pin 34 andbiased apart by handle spring 38. Inner rod 18 is connected to pivotablehandle 32 by pin 33 which engages groove 108 formed in the inner rod.Handles 30 and 32 are shown with finger loops, 35 and 36 respectively,which facilitate grasping by the surgeon.

Latching mechanism 54 is disposed within handle bore 46 and has a latchbutton 48, which is upwardly or perpendicularly biased by spring 50.Inner rod 18 passes through latch button 48 at orifice 44 (FIG. 4A).Orifice 44 in latch button 48 includes U-shaped protrusion 114 which isconfigured and dimensioned to engage axial groove 106 of inner rod 18,the movement of which is described below.

Rotating collar 42 is fixedly secured around outer tube 16 and functionsto enable a surgeon to rotate endoscopic portion 14 and distal fastenerremoving assembly 20 to align the removing assembly with the base of afastener.

In operation, endoscopic portion 14 and fastener removing assembly 20are inserted into the body through a cannula, which is well known in theart. The surgeon can then rotate collar 42 to cause outer tube 16, innerrod 18 and, consequently, fastener removing assembly 20, to orient forks24 and 24' to the desired position for engagement of the fastener to beremoved. The surgeon positions forks 24 and 24' on the fastener, (seeFIG. 6A) and moves proximal pivotable handle 32 distally from a firstopen position to a second closed position (see FIG. 4, arrow 116) toactuate fastener removing assembly 20. More specifically, this movementof handle 32 causes inner rod 18 to slide proximally further causingattached channel 22 to slide in the same direction (see FIG. 4, arrow118). The proximal movement of channel 22 causes the fastener to moveproximally and become wedged between forks 24 and 24' and stationarymember 28. Further proximal movement of channel 22 causes the fastenerbackspan to distort against stationary member 28 which causes thefastener legs to bend outward, resulting in the fastener distorting to aconfiguration suitable for removal as shown in FIG. 6B. When inner rod18 has moved a sufficient distance proximally, such that axial groove106 is in alignment with opening 44 of latch button 48, spring 50 willforce latch button 48 upwardly in the direction of arrow 120. Protrusion114 will engage axial groove 106, and thereby secure inner rod 18 in alocked position. Thus, movement of inner rod 18 is prevented, whichfurther prevents movement of forks 24, 24', reducing the likelihood thata removed fastener will slip from the apparatus and fall into the bodycavity.

The apparatus may then be returned to its unactuated position (i.e.,handles open) as shown in FIG. 5, by depressing latch button 48 oflatching mechanism 54 in the direction of arrow 122. Such depression oflatch button 48 causes protrusion 114 to disengage from axial groove 106to release inner rod 18. Once inner rod 18 is released, handle returnspring 38 will move pivotable handle 32 proximally into its openposition (see arrow 124), thereby allowing inner rod 18 and channel 22to move distally (arrow 126) to their initial position.

FIG. 7 illustrates an alternative embodiment of the endoscopic orlaparoscopic surgical apparatus. Surgical fastener remover 60 comprisesendoscopic portion 64, which is configured and dimensioned to beinserted into a cannula, assembly 62 and fastener removing assembly 70.Handle assembly 62 is positioned at the proximal end of endoscopicportion 64 and functions to actuate the fastener removing assembly 70,which is positioned at the distal end of endoscopic portion 64. Thefastener removing assembly 70 of this embodiment has a movable member,which functions to press against and deform the backspan of a fastener,and a stationary member having parallel spaced apart forks, whichfunctions to engage and hold the backspan of a fastener while themoveable member presses on the backspan.

FIG. 10 illustrates fastener removing assembly 70 and its relationshipwith endoscopic portion 64. Endoscopic portion 64 includes outer tube 66and inner rod 68 slidably disposed therein. Nose piece 65 is positionedat a distal end of outer tube 66 with extension 150 sitting within thedistal opening of outer tube 66.

Turning now to the fastener removing assembly, 70, illustrated in FIG.10, the assembly includes stationary channel 72 and moveable member 78positioned therein, both of which are attached nose piece 65 via pin 75.Pin 75 extends through openings 69 and 69' in the distal end of nosepiece 75, through an elongated opening in movable member 78, and throughan opening in stationary channel 72. Elongated slot 79 in moveablemember 78 allows for the member to slide within stationary channel 72.Inner rod 68 is secured to the proximal end of moveable member 78 viaL-shaped extension 71 so that the two pieces are in axial slidingrelationship within nose piece 65.

Movable member 78 preferably includes raised head 82, which functions todepress tissue and enhance exposure of the fastener. Channel 72 issimilar to channel 22 of the previous embodiment in that it has parallelspaced apart forks. The forks may likewise have various configurations,such as those shown in FIGS. 3A and 3B.

The handle assembly 62 of the apparatus includes proximal stationaryhandle 84, distal pivotable handle 86 and latching mechanism 54 as bestshown in FIGS. 8 and 9. Handles 84 and 86 are shown with finger loops,36 and 35 respectively, to facilitate grasping by the surgeon.Stationary handle 84 and pivotable handle 86 are connected by pivot pin34 and biased apart by handle spring 88. Inner rod 68 is connected atits proximal end to pivotable handle 86 by inner rod pin 83. Latchingmechanism 54 is disposed within handle bore 46 and has a latch button 48which is upwardly biased by spring 50. Inner rod 68 interacts with latchbutton 48 in the same manner as the previous embodiment.

In operation, endoscopic portion 64 and fastener removing assembly 70are inserted into the body through a cannula. The surgeon can thenrotate collar 42 to position the fastener removing assembly in thedesired position, and then the forks are placed in engagement with thefastener. As illustrated in FIG. 8, fastener removing assembly 70 maythen be actuated by moving distal pivotable handle 86 proximally from afirst position to a second position (see arrow 128). This movement ofhandle 86 causes inner rod 68 to slide distally causing attached movablemember 78 to slide in the same direction (see arrow 130). Distalmovement of movable member 78 causes the fastener to become wedgedbetween moveable member 78 and forks 24,24' on stationary channel 72.Further distal movement of movable member 78 causes the fastenerbackspan to distort between the forks which causes the fastener legs tobend outward, resulting in the fastener distorting to a configurationsuitable for removal as shown in FIG. 6B. When inner rod 68 has moved asufficient distance distally, spring 50 will force latch 48 upwardly(see arrow 120) to lock inner rod 68 in a fixed position, in a mannersimilar to that described in the previous embodiment.

The apparatus may then be returned to its unactuated position (i.e.,handles open) by depressing latch button 48 (see arrow 122 of FIG. 9).Once inner rod 68 is released, handle spring 88 will force pivotablehandle 86 distally (arrow 132) into the first position thereby allowinginner rod 68 and movable member 78 to move proximally (arrow 134) totheir initial position.

While the invention has been particularly shown and described withreference to the preferred embodiments, it will be understood by thoseskilled in the art that various modifications in form and detail may bemade therein without departing from the scope and spirit of theinvention. Accordingly, such modifications are to be considered withinthe scope of the invention as defined by the claims.

What is claimed is:
 1. A surgical apparatus for removing from the body afastener having a pair of legs joined by a backspan having top andbottom portions, the apparatus comprising:a) an endoscopic portion; b)means positioned at a distal end of said endoscopic portion for removingthe fastener, said fastener removing means comprising a stationarymember and a movable member, wherein said movable member comprisesparallel spaced apart fork means for engaging said backspan; and c)means remote from said distal end of said endoscopic portion foractuating said fastener removing means; wherein said movable memberengages the fastener backspan bottom portion and proximal movement ofsaid movable member moves said fastener proximally to cause saidfastener backspan top portion to press against said stationary memberfurther causing said fastener to deform to a configuration suitable forremoval.
 2. A surgical apparatus for removing from the body a fastenerhaving a pair of legs joined by a backspan having top and bottomportions, the apparatus comprising:a) an endoscopic portion; b) meanspositioned at a distal end of said endoscopic portion for removing thefastener, said fastener removing means comprising a stationary memberand a movable member, wherein said stationary member comprises parallelspaced apart fork means for engaging said backspan; and c) means remotefrom said distal end of said endoscopic portion for actuating saidfastener removing means; wherein said stationary member engages thefastener backspan bottom portion and distal movement of said movablemember causes said movable member to press against said fastenerbackspan top portion further causing said fastener to deform to aconfiguration suitable for removal.
 3. A surgical apparatus according toclaim 2 wherein said fastener removing actuating means comprises ahandle assembly having at least one pivotable handle.
 4. A surgicalapparatus for removing from the body a fastener having a pair of legsjoined by a backspan, the apparatus comprising:a) an endoscopic portion;b) means positioned at a distal end of said endoscopic portion forremoving the fastener, said fastener removing means comprising astationary member and a movable member, wherein said movable membermoves longitudinally along a longitudinal axis of said endoscopicportion and wherein one of said members comprises parallel spaced apartforks; and c) means remote from said distal end of said endoscopicportion for actuating said fastener removing means.
 5. A surgicalapparatus according to claim 4 wherein said endoscopic portion isrotatable relative to said handle assembly.
 6. A surgical apparatusaccording to claim 5 wherein said handle assembly comprises means forrotatably moving said endoscopic portion.
 7. A surgical apparatusaccording to claim 6 wherein said means for rotatably moving saidendoscopic portion comprises a collar positioned around the outer tubeof said endoscopic portion.
 8. A surgical apparatus for removing fromthe body a fastener having a pair of legs joined by a backspan, theapparatus comprising:a) an endoscopic portion comprising an outer tubeand an inner rod slidably disposed therein; b) means positioned at adistal end of said endoscopic portion for removing a fastener, saidfastener removing means comprising parallel spaced apart forks; and c)means remote from said distal end of said endoscopic portion foractuating said fastener removing means, said actuating means comprisinga handle assembly having at least one pivotable handle and wherein saidinner rod is secured to said at least one pivotable handle.
 9. Asurgical apparatus according to claim 8 wherein said at least onepivotable handle is movable from a first position to a second positionand further comprising means for retaining said at least one pivotablehandle is said second position.
 10. A surgical apparatus according toclaim 9 wherein said means for retaining said at least one pivotinghandle comprises a latching member disposed within a bore in said handleassembly and said latching member retaining said inner rod in a lockedposition.
 11. A surgical apparatus according to claim 10 wherein saidlatching member comprises an orifice through which said inner rod passesand a protrusion disposed within said orifice which is configured anddimensioned to engage an axial groove in said inner rod.
 12. A surgicalapparatus according to claim 10 comprising means for releasing saidlatching member.
 13. A surgical apparatus according to claim 8 whereinsaid fastener removing means further comprises a stationary member and amovable member.
 14. A surgical apparatus according to claim 13 whereinsaid forks are movable and cooperate with said inner rod of saidendoscopic portion.
 15. A surgical apparatus according to claim 14wherein said parallel spaced apart forks engage the backspan of saidfastener and proximal movement of said forks causes proximal movement ofsaid fastener causing said backspan to press against said stationarymember further causing said fastener to deform to a configurationsuitable for removal.
 16. A surgical apparatus according to claim 13wherein said parallel spaced apart forks are stationary and engage thebackspan of said fastener and distal movement of said movable membercauses said movable member to press against said backspan furthercausing said fastener to deform to a configuration suitable for removal.17. A surgical apparatus configured and dimensioned for insertionthrough a cannula comprising:a) an endoscopic portion comprising anouter tube and an inner rod slidably disposed therein; b) tool meanspositioned at a distal end of said endoscopic portion, said inner rodcooperating with said tool means; c) means remote from a distal end ofsaid endoscopic portion for manipulating said inner rod; and d) meansfor locking said inner rod in a fixed position, said locking meanscomprising a latching member slidable in a direction substantiallyperpendicular to said endoscopic portion and engaging said inner rod.18. A surgical apparatus according to claim 17 wherein said latchingmember is positioned within a bore in said manipulating means andcomprises an orifice through which said inner rod passes.
 19. A surgicalapparatus according to claim 18 wherein said latching member furthercomprises a protrusion which is configured and dimensioned to engage anaxial grove in said inner rod.
 20. A surgical apparatus according toclaim 19 comprising means for releasing said latching member.
 21. Asurgical apparatus according to claim 17 wherein said latching member isspring biased upwardly.
 22. A surgical apparatus according to claim 17wherein said tool means comprises means for removing from the body afastener having a pair of legs joined by a backspan.
 23. A surgicalapparatus for removing from the body a fastener having a pair of legsjoined by a backspan, the apparatus comprising:a) an endoscopic portion;b) means positioned at a distal end of said endoscopic portion forremoving the fastener, said fastener removing means comprising astationary member and a movable member, wherein said movable membermoves longitudinally along a longitudinal axis of said endoscopicportion; c) actuating means positioned at a proximal end of saidendoscopic portion for actuating said fastener removing means; andlocking means disposed in said actuating means for locking said movablemember in a fixed position.
 24. A surgical apparatus according to claim23 wherein said movable member comprises parallel spaced apart forks.25. A surgical apparatus according to claim 23 wherein said stationarymember comprises parallel spaced apart forks.
 26. A surgical apparatusaccording to claim 23 wherein said actuating means comprises a handleassembly.